The 1918 influenza pandemic, also known as the Spanish flu, infected approximately 500 million people and killed anywhere from 17-100 million over a period of two years. For the duration of the pandemic, Americans utilized various measures to slow the spread of the virus. There were no antivirals at the time, or antibiotics to treat any subsequent conditions after an influenza infection. As a result, most public health operations were directed at prevention. (CDC)
In September 1918, the second wave began and would prove to be the most fatal period of the pandemic. Cities closed down large gathering places and prohibited all public gatherings. Stores were encouraged to limit the amount of occupants in their stores, and citizens were asked to walk instead of taking public transportation when possible. Most cities had experienced significant losses by December 1918 when health officials issued directives to beware the “dangers of coughing and sneezing; careless disposal of ‘nasal discharges’.” (CDC) Many people were concerned with nasal discharges and also spit, as shown in the poster. Additionally, Dr. W.A. Evans issued advice on spit to a concerned subscriber in his column “How to Keep Well”. Streetcars in Philadelphia sported signs reading, “spit spreads death.” (History.com) (See pictures below)
Some places ended their public health measures very quickly. San Francisco did take the extra step in forcing all people to wear masks when in public. However, this prompted an outcry from the city and even led to the formation of an organization known as the Anti-Mask League of San Francisco. Soon after, the ordinance was repealed and people were free to not wear masks. Public health officials and concerned citizens resorted to social pressure to increase compliance with the masks. (History.com) Also, Seattle lifted gathering restrictions after only six weeks. 15 year old Violet Harris remarked in her diary, “The ban was lifted to-day. No more …. masks. Everything open too. ‘The Romance of Tarzan’ is on at the Coliseum [movie theater] as it was about 6 weeks ago. I’d like to see it awfully. …. School opens this week—Thursday! Did you ever? As if they couldn’t have waited till Monday!” (Smithsonian Diaries) She doesn’t remark on the implications of the city’s reopening for the pandemic. Rather, she is excited to go back to the movie theater, and unhappy to go back to school. It is unknown how much of a priority young people placed on socializing over preventing the flu’s spread.


Additional source: ‘Mask Slackers’ and ‘Deadly’ Spit: The 1918 Flu Campaigns to Shame People Into Following New Rules https://www.history.com/news/1918-pandemic-public-health-campaigns